Monday, March 5, 2018

UPDATE: Feds OK Medicaid work rule; no decision yet on restricting enrollment on income

NO WORK, NO MEDICAID: that was the news today at session with Gov. Asa Hutchinson, federal Medicaid director Seema Verma (right) and DHS Director Cindy Gillespie.

Seema Verma, the director of the federal Center for Medicare and Medicaid Services will be in Little Rock this morning and is expected to announce with Gov. Asa Hutchinson decisions on his requests for waivers in the Arkansas Medicaid expansion program.

UPDATE: A work requirement was approved; a bigger change that could cut Medicaid for 60,000 people remains under discussion.

One change is a work requirement. Verma has already approved a work requirement for Kentucky, though Arkansas's proposal is more punitive. You must go without coverage for most of a year after losing eligibility, while Kentucky allows a recipient to work her way immediately back to coverage. Kentucky's rule is under challenge in federal court. If Verma does approve the change for Arkansas as expected it could meet a court test, too.

The big change under review is to allow only people who make 100 percent of the federal poverty level or less qualify, or about $12,000, for coverage, rather than 138 percent. This will slice some 60,000 people off health coverage, a life or death decision for some in that number. It will save Arkansas $15 to $20 million (In a $6 billion state budget). Politico wrote last week that many believe Verma won't approve this change. While it would save money for Arkansas and much more for the federal government, it would have the effect of encouraging participation by 20 states that now don't participate in the Medicaid expansion enabled by Obamacare. This change, too, is fraught with legal questions.

Benji Hardy will be covering the session with the governor and Verma. More later.

At some point after the decision, I expect we'll hear from U.S. Sen. Ron Wyden. He's previously raised questions about Verma's conflict of interest in making decisions about the Arkansas Medicaid program. She served as a paid consultant to Hewlett Packard when it was providing services to Arkansas on its Medicaid program. Her agency and Arkansas have said she has permission to work on Arkansas matters.

The Arkansas legislature, in session on budget matters, will be tuning in to the Verma-Hutchinson session. Still pending in the legislative session is the Department of Human Services budget, which includes the entire Medicaid program. A small but significant minority of ultra-conservative Republican legislators oppose the Medicaid expansion program. A three-fourths vote is required in Senate and House to pass the legislation. That means 27 votes in the 35-member Senate, where three seats are currently vacant. The appropriation for DHS came out of Joint Budget Monday afternoon, but that's not much of a read on what awaits in the Senate and House.

The work rule will save the state a few million dollars. As many as 39,000 people on Medicaid may be affected. But there's no firm number. Many who don't work are unable to work. And there are exemptions for single parents, the disabled, people over 50 and others.

The governor issued this statement:

Governor Asa Hutchinson announced Monday that the federal Centers for Medicare and Medicaid Services (CMS) has approved the State’s request to implement a work requirement for Arkansas Works enrollees. With this approval, Arkansas becomes one of only three states that currently mandates work for people who want to keep health benefits funded by Medicaid expansion dollars. Governor Hutchinson said the change promotes personal responsibility and will help low-income Arkansans move up the economic ladder.

“I have often said that Arkansans understand the dignity of work,” Governor Hutchinson said. “The approval of this work requirement will go a long way to create opportunities for able-bodied working-age Arkansans to enter into training or employment and ultimately climb the economic ladder.

“With federal approval of this requirement, Arkansas has become a national leader in rethinking the delivery of public assistance. Although Arkansas’ work requirement is one of the most stringent in the nation, it is not designed to be punitive, but to better serve the needs of Arkansans by creating pathways for individuals to take steps toward financial independence. CMS, under the leadership of Administrator Verma, understands this and has been a great partner in these efforts. I appreciate the work of all those who have put in long hours designing a program that is better tailored to serve and improve the lives of Arkansans.”

CMS Administrator Seema Verma was in Arkansas on Monday for the Governor’s announcement.

“The Trump administration is dedicated to advancing policies that make Medicaid a pathway out of poverty by empowering states like Arkansas to design programs that meet the unique needs of their citizens,” Administrator Verma said. “We owe it to Americans all across this country to support new ideas and innovative solutions to improve health outcomes that can promote upward mobility and an improved quality of life.”

Arkansas Works is a unique program that uses Medicaid expansion dollars to buy private health insurance for eligible individuals. Last summer, the Arkansas Department of Human Services submitted to CMS an 1115 waiver request to implement a work requirement, and the two agencies have spent the last several months finalizing terms and conditions for the new requirement. Arkansas has had a “work referral” process in place over the last year, tracking the outcomes for people who are referred to Department of Workforce Services for assistance in job search and training. The results of the referral showed that individuals who take advantage of these services are more likely to find a job than those who do not. Shifting from a voluntary “referral” to a mandatory requirement that individuals work in order to receive their health insurance is expected to increase the number of enrollees who take advantage of state programs to assist in developing skills and obtaining jobs.

“DHS is moving to immediately implement the work requirement for Arkansas Works,” Arkansas Department of Human Services Director Cindy Gillespie said. “We’ll notify enrollees this month that their health benefit is now subject to a work requirement and the first group of enrollees will begin reporting on their work activities in June. We’re working with the health insurance carriers, the Department of Workforce Services, Arkansas Foundation for Medical Care, the education community and many others to have a robust program that connects people with resources that can help them meet the work requirement. Work and community engagement is a positive factor for a healthy life and we’re excited to help our fellow Arkansans improve their skills and get new or better jobs because we know that can change their lives for the better.”

Arkansas Works enrollees who are 19 to 49 years old will be subject to the work requirement. The requirement will be phased in on the 30-49 year-olds first over a four-month period between June and September of 2018. Individuals subject to the work or community engagement requirement must report 80 hours of work activity every month or show that they are exempt from reporting work activities. A work activity can include a job, job training, job searching, school, health education classes, or volunteering/community engagement (or a combination of any of these for a total of 80 hours). Activity must be reported online at www.access.arkansas.gov. If an enrollee fails to meet the work or community engagement requirement for any three months in a calendar year, he or she will lose Arkansas Works coverage for the remainder of that calendar year.

An enrollee is considered exempt if he or she is medically frail, exempt from SNAP work requirement, receives TEA assistance, pregnant, caring for an incapacitated person, short-term incapacitated, in substance abuse treatment or full-time education, has a minor child in his/her home or already works at least 80 hours a month.

Arkansas Advocates for Children and Families commented:

Today, Arkansas received federal approval to add a work requirement to the Arkansas Works program, which provides affordable coverage to 285,000 low-income Arkansans who have no other coverage options and rely on this program to get the care they need. Although federal approval did not go as far as lowering the income eligibility level, we’re deeply troubled by the changes that will come with work requirements.

Work requirements are a political move that do nothing to address the very real challenge that many Arkansans face – a lack of meaningful employment opportunities that offer a livable wage and benefits. This policy is also based on the false assumption that Arkansas Works enrollees are not contributing to their communities in valuable ways. The fact is the majority of people enrolled in Arkansas Works are already working, enrolled in school, retired, or taking care of an ailing relative or dependent child. That means this policy will only add unnecessary costs and new administrative hurdles to a health care system that’s already difficult to navigate. Many Arkansans, including working people and people with disabilities, will lose coverage because they can’t overcome bureaucratic red tape to document that they meet work requirements or qualify for an exemption.

Arkansans deserve better.

Instead of creating costly and punitive new requirements designed to kick people who need health care off the program, our leaders should continue to promote the purpose of the Medicaid program to provide health coverage for low-income Arkansans without unnecessary barriers.

We call on state leaders to address the real issues that cause high poverty rates and lack of employment opportunities in the state. We can no longer rely on solutions that satisfy political interests but ignore struggling families in Arkansas.

Arkansas Community Organizations also was critical:

Over the last five years Arkansas extended quality, affordable health coverage to over 300,000 adult Arkansas citizens. The implementation of Arkansas Works cut our uninsured rate in half. Today’s announcement by CMS Administrator Seema Verma to grant Arkansas a waiver to impose a work requirement on people enrolled in the Arkansas Works program will increase the number of uninsured people in our state and is a step backwards. We strongly urge Administrator Verma NOT to approve the other components of Arkansas’s waiver request including lowering the eligibility threshold to 100% of the poverty level..

“We believe that health care is a human right. We urge the Governor and the state legislature to fund Arkansas Works, reconsider implementing the waiver and look for ways to make health care accessible to all Arkansans. Health care is a necessity. Tax breaks for people earning above $75,000 is a luxury.”

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